Home blood pressure monitoring and equity challenges of the 2025 ACC/AHA hypertension guideline in Africa

The 2025 ACC/AHA hypertension guideline reaffirms < 130/80 mmHg as the treatment target and elevates home blood pressure monitoring (HBPM) as the diagnostic gold standard. While this represents progress in hypertension management, it risks widening inequities in Africa, where validated HBPM devices are scarce, unaffordable, and largely excluded from public health systems. Fewer than 10% of households in sub-Saharan Africa own a validated monitor, compared with more than 60% in high-income countries, and retail prices often exceed a week's income. Without deliberate policy action, accurate diagnosis and follow-up may become privileges reserved for wealthier populations, while most patients continue to rely on single clinic readings. Evidence from Ghana, Nigeria, Kenya, and Ethiopia highlights systemic barriers, including device shortages, weak procurement systems, financing gaps, and limited awareness, that undermine hypertension care. To align with international standards, African health systems must recognize HBPM as an essential health technology, add validated devices to national essential lists, and mobilize sustainable financing for procurement. Regional pooled purchasing, local manufacturing, and donor support could reduce costs and improve supply security. Embedding HBPM into hypertension pathways is not only a technical priority but also an equity imperative to close the global treatment gap.